Deep South, Midwest Seen as Key to Cutting U.S. Smoking Rate

(Bloomberg) -- The average smoking rate in the U.S. has declined significantly over the past several decades. That's the good news. The bad news is that a group of 12 contiguous states in the Deep South and Midwest is lagging behind.

Referred to as “Tobacco Nation” in a new report from the Truth Initiative, an anti-smoking group, the region consists of Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Tennessee and West Virginia.  In those states, 22 percent of adults smoke, compared with 15 percent in the rest of the U.S., giving the area the highest concentration of smokers in the nation.

“We think of the United States as being the most technologically advanced, richest nation in the world, with access to some of the best science and health care,” said Robin Koval, president of the Washington-based Truth Initiative. “Yet when you look at what we call Tobacco Nation, it looks more like a part of the developing world than it looks like the United States of America.”

Smoking rates in the 12-state region have declined over time, though at a slower pace than in the rest of the country. That's had consequences for public health. Tobacco-related conditions including lung and other cancers, heart disease and chronic lower respiratory ailments are more prevalent in those states, according to the report.

The states, which account for about 20 percent of the U.S. population, are poorer and less educated than the rest of the nation. The have lower excise taxes on average and fewer laws that prevent smokers from lighting up in workplaces, restaurants and bars. In addition to supporting such taxes and laws, the Truth Initiative calls for raising the minimum age for purchasing cigarettes to 21.

FDA Policy

The Truth Initiative report comes as the U.S. Food and Drug Administration's tobacco policy is in the spotlight. FDA Commissioner Scott Gottlieb proposed policies in July that would reduce the amount of nicotine in combustible cigarettes and make it easier for less-harmful nicotine delivery systems to hit store shelves. If enacted, it would be the most sweeping tobacco regulation since 1965.

Philip Morris International Inc., the second-largest publicly traded tobacco company, has also jumped on the anti-cigarette train. Chief Executive Office Andre Calantzopoulos has said the company is working toward a future where all smokers have transitioned to reduced-risk products. Still, the company sold 813 billion cigarettes in 2016.

Federal and state efforts to reduce smoking have worked in the past. States with higher excise taxes on cigarettes and more robust anti-smoking regulations and educational programs have successfully reduced smoking. The national smoking rate declined 5.8 percentage points to 15.1 percent between 2005 and 2015, according to the Centers for Disease Control and Prevention.

Former New York City Mayor Michael Bloomberg instituted a series of smoking bans in workplaces -- including bars, restaurants and nightclubs -- beginning in 2003. He credited those measures to increasing the average life expectancy in the city. Bloomberg is the founder and majority owner of Bloomberg LP, the parent company of Bloomberg News.

To contact the reporter on this story: Jennifer Kaplan in New York at jkaplan84@bloomberg.net.

To contact the editors responsible for this story: Nick Turner at nturner7@bloomberg.net, Mark Schoifet, Jonathan Roeder